Immune-Mediated Inflammatory Skin Disease in Middle Eastern and North African Populations: Atopic Dermatitis at the Intersection of Biology, Culture, and Structural Inequity
Abstract
Atopic dermatitis (AD), a prototypical immune-mediated inflammatory disease, represents a growing and underrecognized public health burden among Middle Eastern and North African (MENA) populations. Global estimates suggest that AD affects more than 170 million individuals worldwide, with increasing prevalence in low- and middle-income regions undergoing rapid urbanization, including much of the MENA region. Despite this growing impact, MENA populations remain underrepresented in epidemiologic datasets and in the development of clinical trial guidelines. This narrative review examines current evidence on AD in MENA populations, integrating insights on epidemiology, immunopathogenesis, clinical phenotype, socio-cultural context, health system capacity, and geopolitical determinants. In addition to clinical and immunopathological considerations, particular emphasis is placed on unmet needs, quality-of-life impact, and structural barriers to care. Gaining an understanding of these region-specific factors is essential for dermatologists caring for patients of MENA ancestry and for the developmentof equitable, context-sensitive management strategies.
References
Cao X, Wang M, Zhou M, Mi Y, Guo Q, Fan Y, et al. Global, regional and national burden of paediatric atopic dermatitis. Clin Exp Allergy. 2024;54(10):747-759. doi:10.1111/cea.14558
Faye O, Flohr C, Kabashima K, Ma L, Paller AS, Rapelanoro FR, et al. Atopic dermatitis: a global health perspective. J Eur Acad Dermatol Venereol. 2024;38(5):801-811. doi:10.1111/jdv.19723
Mosam A, Todd G. Global epidemiology and disparities in atopic dermatitis. Br J Dermatol. 2023;188(6):726-737. doi:10.1093/bjd/ljad042
Taib M. 2015 Minerals Yearbook The Middle East and North Africa [Advance Release]. In: 2015 Minerals Yearbook. United States. U.S. Department of the Interior;2019. [cited 13 January 2026].
Kashmar M, Alsufyani MA, Ghalamkarpour F, Chalouhi M, Alomer G, Ghannam S, et al. Consensus opinions on facial beauty and implications for aesthetic treatment in Middle Eastern Women. Plast Reconstr Surg Glob Open. 2019;7(4):e2220. Published 2019 Apr 25. doi:10.1097/GOX.0000000000002220
Safiri S, Jaberinezhad M, Mousavi SE, Motlagh Asghari K, Shamekh A, Nejadghaderi SA, et al. The burden of dermatitis from 1990-2019 in the Middle East and North Africa region. BMC Public Health. 2024;24:399. Published 2024 Feb 7. doi:10.1186/s12889-024-17836-z
Silverberg JI, Barbarot S, Gadkari A, Simpson EL, Weidinger S, Mina-Osorio P, et al. Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study. Ann Allergy Asthma Immunol. 2021;126(4):417-428.e2. doi:10.1016/j.anai.2020.12.020
Asher MI, Montefort S, Björkstén B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733-743. doi:10.1016/S0140-6736(06)69283-0
Mahmoud O, Yosipovitch G, Attia E. Burden of disease and unmet needs in the diagnosis and management of atopic dermatitis in the Arabic population of the Middle East. J Clin Med. 2023;12(14):4675. Published 2023 Jul 14. doi:10.3390/jcm12144675
Gupta J, Margolis DJ. Filaggrin gene mutations with special reference to atopic dermatitis. Curr Treat Options Allergy. 2020;7(3):403-413. doi:10.1007/s40521-020-00271-x
Al-Afif KAM, Buraik MA, Buddenkotte J, Mounir M, Gerber R, Ahmed HM, et al. Understanding the burden of atopic dermatitis in Africa and the Middle East. Dermatol Ther (Heidelb). 2019;(2)9:223-241. doi:10.1007/s13555-019-0285-2
Elezbawy B, Fasseeh AN, Fouly E, Tannira M, Dalle H, Aderian S, et al. Humanistic and economic burden of atopic dermatitis in the Middle East and Africa region. Dermatol Ther (Heidelb). 2023;13(1):131-146. doi:10.1007/s13555-022-00857-0
Khatib CM, Klein-Petersen AW, Rønnstad ATM, Egeberg A, Christensen MO, Silverberg JI, et al. Increased loss-of-function filaggrin gene mutation prevalence in atopic dermatitis patients across northern latitudes indicates genetic fitness: a systematic review and meta-analysis. Exp Dermatol. 2024;33(7):e15130. doi:10.1111/exd.15130
Smieszek SP, Welsh S, Xiao C, Wang J, Polymeropoulos C, Birznieks G, et al. Correlation of age-of-onset of atopic dermatitis with filaggrin loss-of-function variant status. Sci Rep. 2020;10(1):2721. Published 2020 Feb 17. doi:10.1038/s41598-020-59627-7
Bissonnette R, Goleva E, Berdyshev E, Leung DYM. Response to: Dupilumab treatment restores lesional and nonlesional skin barrier function in adults and adolescents with atopic dermatitis irrespective of the filaggrin genotype: results from an open-label, healthy control-matched, phase 4 clinical study (BALISTAD). J Am Acad Dermatol. 2026;94(1):e45-e46. doi:10.1016/j.jaad.2025.08.070
Ramadan M, Solyman S, Yones M, Abdallah Y, Halaby H, Hanora A. kin Microbiome Differences in Atopic Dermatitis and Healthy Controls in Egyptian Children and Adults, and Association with Serum Immunoglobulin E. OMICS. 2019;23(5):247-260. doi:10.1089/omi.2019.0011
Widaty S, Surachmiati L, Legiawati, L Sirait SP, Krisanti IA, Budianti WK, et al. Scalp of healthy women wearing hijab compared to those not wearing hijab: a cross-sectional study. Sci Rep. 2023;13(1):11797. Published 2023 Jul 21. doi:10.1038/s41598-023-38903-2
Budair FM. Dermatoses associated with Arabic cultural and traditional practices. Indian J Dermatol Venereol Leprol. 2019;85(5):448-454. doi:10.4103/ijdvl.IJDVL_123_18
Elezbawy B, Fasseeh AN, Fouly E, Tannira M, Dalle H, Aderian S, et al. Humanistic and economic burden of atopic dermatitis for adults in the Middle East and Africa. Dermatol Ther (Heidelb). 2023;13:131-146. doi:10.1007/s13555-022-00857-0
ElSayed M, Ragab M, El Khoury J, Kurban M, Ghoubar M, Hassan N. Patient awareness, education, and support for atopic dermatitis in Egypt and Lebanon: results of a physician survey and social analytics. Dermatol Ther. 2024;2024 Article ID 5534555, 11 pages. https://doi.org/10.1155/2024/5534555
